Archive | November, 2013

Selincro & IBA

21 Nov

Really interesting post by Dylan Kerr Clinical Nurse Manager at HAGA today on Alcohol Policy UK about Selincro…a new drug for treatment of mild to moderate dependence in conjunction with psychosocial interventions.

This post raises some very important issues and concerns – about medicalisation, and how appropriately the drug will be used in practice.

For me these issues relate to whether the drug will lead to medicalisation of a level of alcohol problem that would not normally be medicated.  The issue of medicalisation is well recognised, and relates to the impact of marketing activities on perceptions of health and illness such that issues and problems that people experience, become highlighted in such a way that more people are led to believe they have medical conditions which can, or even ought, to be treated with medication.  This process is at its most stark as described previously by Moynihan.

With Selincro, the problem it is seeking to tackle (mild alcohol dependence) clearly exists. In re-defining responses to it, however, there is a risk that it moves the alcohol treatment field a little further away from behavioural approaches and backwards (I would argue) to a medicalised view of alcohol problems…to a place where people could see themselves as having less control over their own behaviour.  The idea of personal responsibility and control is a central tenet of IBA and brief motivational interventions in general.

Given previous posts about why professionals are reluctant to talk about alcohol anyway, many will be attracted to the idea of Selincro if they (mistakenly) feel that it offers a quick way to deal with this middle group of drinkers.  The history of off-label or inappropriate use of medicines (some would argue as a result of the marketing activities of pharmaceutical companies) (Orlowski,1992), also suggests that Dylan’s concerns about it being used without the psychosocial interventions may not be not entirely unreasonable.  We can already see extensive marketing efforts from Lundbeck in sponsoring alcohol conferences (most recently Alcohol Concern 2013, and INEBRIA 2013), and may wonder at the purpose, influence, and appropriateness of such funding.

What training will be provided to doctors prescribing Selincro to deliver the psychosocial intervention?  Will that training also describe the evidence base for psychosocial interventions alone?  Will it discuss natural recovery from alcohol dependence?  As the IBA/BI field seeks to fill gaps in knowledge about what effective content in BI looks like, will optimal psychosocial interventions represent a better investment?  And if the health service spent the cost of Selincro on improving delivery of BIs over multiple sessions, would that be more effective and cost-effective?  The gaps in research about effective BI content provide a ripe marketplace for Selincro, and make further independent research not only important, but urgent.

As a postscript, I just signed up to the Selincro website for health professionals (I am a registered pharmacist).  2 of the first headlines flashing at me do not fill me with confidence either on the medicalisation or marketing issues.

First headline I see: Selincro (nalmefene) reduces alcohol consumption by 61%.  Studies have shown that patients taking Selincro reduced consumption from 10.5 to 4 bottles of wine per week after 6 months’ treatment.

No mention of the fact that the effective treatment was Selincro (nalmefene) with psychosocial intervention…here.  This information appears as a footnote in the page ‘about Selincro’.

Second headline I see: Alcohol dependence is a medical illness.   Alcohol dependence is a chronic relapsing brain disease that is characterised by compulsive alcohol seeking and use, despite harmful consequences.

Now this may be true when you look at treatment populations but fails to recognise the much larger group of people who recover by themselves.  The problems with the term ‘chronic relapsing disorder’  (never mind ‘brain disease’) are discussed by Jim McCambridge in his recent FEAD video post.

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Are we using social media enough to enhance alcohol working?

7 Nov

In this guest post Richard Gratton, a specialist substance misuse nurse for Chesterfield Royal Hospital NHS Foundation Trust (Derbyshire, UK) writes about the missed social media opportunities for the field. Richard also writes his own blog positivebehaviourchange.blogspot.co.uk

In recent years, the use of social media by professionals has increased exponentially, and health organisations are no exception. Whilst there should be some caution in terms of the type of information and comment that is broadcast, on the whole it has had a positive impact on the way we provide healthcare.Twitter

Social media has for instance led to improvements in communication between staff and patients, and enhanced the dissemination of information, learning or messages. In addition it has greatly helped networking between staff in ways that were previously not possible.

I currently work as service lead for the Hospital Alcohol and Drug Liaison Team at Chesterfield Royal Hospital NHS Foundation Trust (Derbyshire, UK). The team consists of 2 nurses providing a range of specialist interventions where substance misuse is a feature of patient’s lifestyle. It also plays a vital role in improving the knowledge and skills of the hospital workforce (such as in IBA) and enhancing the effectiveness of the local treatment system.

Around 5 years ago, the majority of hospitals in the UK did not employ substance misuse workers; only a handful of services existed, which to some extent caused isolated working and pockets of good practice. It is now thought that more than 65% of hospitals employ at least one worker, with growing evidence of the impact of these roles.  Further benefits to patient care and increased opportunities to engage with people on substance misuse issues are also apparent.

For hospital-based substance misuse services sharing of good practice includes a forum on the Alcohol Learning Centre and a Liaison Network, but missed opportunities for more through social media. The same can probably be said for the IBA agenda.

In my experience social media should be considered by all those working in the substance misuse field or delivering health interventions like IBA for the following reasons:

Twitter:

  • ’Tweeting’ can be an excellent way of commenting on good practice, sharing innovations in your area of work, and providing links to useful articles and comment.
  • Using hashtags to bookmark discussions allows for debate amongst like-minded people in regard to contemporary issues: #wenurses is an excellent example of this, providing a weekly platform to debate contemporary issues. An #alcoholiba tag is sometimes used too.

Blogs:

  • Writing a regular blog on a variety of issues can be a great method of sharing good practice and encouraging others to improve their knowledge and skills in a particular area.
  • Many blogs will welcome ‘guest posts’ such as the one you are reading now!

Facebook:

  • What was traditionally a truly ‘social’ media has increasingly become a platform for all kinds of professional information, events and information sharing

Whilst social media does not provide a single answer, it can be a crucial tool to enhance our practice and foster healthy debate about substance misuse work. So whether it’s exploring specialists’ role in the provision of IBA, or issues such as the treatment of alcohol withdrawal syndrome, social media is an opportunity to highlight the good work that we do, enhance knowledge, improve the consistency of approaches and share learning and innovative practice.

Greater use of social media has the potential to bring with it significant benefits to our practice and the care that we provide to patients.

See here for a recent Guardian piece on Five powerful ways to increase your social impact with social media.